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March 1, 2021Open HeartOpen Access

Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction

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Why the study?

Real-world utilization of guideline-directed medical therapies in HFrEF remains low, and it is unclear how recently proven SGLT2 inhibitors should be integrated alongside established therapies.

Does a parallel approach to initiating the four pillars of heart failure therapy improve treatment optimization in patients with HFrEF compared to a linear approach?

Comparison

Parallel approach vs linear approach to initiating and optimizing HFrEF therapies

Design

Viewpoint

Authors

SSSam StrawMMMelanie McGinlayKWKlaus K. Witte

Discussion

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Member takes

Overview

Parallel pillar initiation may simplify HFrEF optimization; leaves open whether this improves outcomes versus linear sequencing.

Structured PICO

Does a parallel approach to initiating the four pillars of heart failure therapy improve treatment optimization in patients with HFrEF compared to a linear approach?

P
Population
Patients with heart failure with reduced ejection fraction (HFrEF)
I
Intervention
Parallel approach to the initiation and optimization of the Four Pillars of Heart Failure (renin-angiotensin system inhibitors/ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors)
C
Comparator
Current linear approach to pharmacotherapy initiation

Transitioning from a linear to a parallel approach for initiating the four pillars of HFrEF therapy could simplify management and improve the attainment of optimal medical therapy.

Cite This Study

Straw et al. (2021) studied this question.

synapsesocial.com/papers/69ce3e89dbdecb594e387b8ahttps://doi.org/10.1136/openhrt-2021-001585
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart Failure1991 · 8,072 citations
  2. 2Digoxin in Heart Failure with a Reduced Ejection Fraction: A Risk Factor or a Risk Marker?2016 · 871 citations
  3. 32016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure2016 · 11,597 citations
  4. 4Comparative Effects of Low and High Doses of the Angiotensin-Converting Enzyme Inhibitor, Lisinopril, on Morbidity and Mortality in Chronic Heart Failure1999 · 1,248 citations
  5. 5Initiation of Sacubitril/Valsartan in Haemodynamically Stabilised Heart Failure Patients in Hospital or Early After Discharge: Primary Results of the Randomised TRANSITION Study2019 · 354 citations